Provider Demographics
NPI:1861030900
Name:MIKHAIL, LILIAN ADEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LILIAN
Middle Name:ADEL
Last Name:MIKHAIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 DEER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-7645
Mailing Address - Country:US
Mailing Address - Phone:352-872-3669
Mailing Address - Fax:
Practice Address - Street 1:2483 N LANCEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-8433
Practice Address - Country:US
Practice Address - Phone:352-872-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1046001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104600Medicaid